Beating the dead horse....

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Beating the dead horse....

Postby kwirl » Mon Dec 08, 2008 1:08 am

I know it has been touched upon before, and has probably even starred in some of its very own debated threads, but I feel that there is cause to bring this topic back to life anew.

Health Care. That dreaded word, which spawns debates more annoying than god, politics, and party fouls combined. The 'new' factor is that our president-elect is inviting community participation and asking for public input in shaping the new health care package when he comes into office.

Now I realize that this could be a bunch of pandering to public attention, but I argue that it could in all honesty be a serious attempt at finding a legitimate and functional solution to a problem that has no desire to cure itself.

What existing reform have you seen that would have a real and significant chance of making a difference? Does anyone have their own ideas that they care to put forward for debate and discussion?

While I am obviously a democrat, I will admit that there were republican options that I felt would have done a good job, McCain/Palin being not among those options. However, this attempt at holding an open line of communication by the president-elect with the people who elected him into that office makes me feel somewhat inspired. Inspired by the fact that despite his being just another 'politician' - I feel like he cares what I think. He cares what other people thinks. He won't be looking to a centuries-old textbook for social and political manipulation to guide his decisions, it almost feels like he wants to make informed choices that represent the views and needs of his constituants. It's a matter of time before my cornflakes are pissed upon, I know. But until that time, I feel that the least I can do as a citizen is to open and participate in what choices will be made on my behalf by our nation.

So if anyone wants to chime in with their thoughts, throw around some ideas and experiences, I'd like to participate and see the results of the discussion with the broad range of intellectual and professional presences that are in this forum.

Thanks.

//personal insults should be directed at me via PM since I don't check them, anyway!
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Re: Beating the dead horse....

Postby Gormal » Mon Dec 08, 2008 9:40 am

Stopped reading when you called health care “The Dreaded Word”.
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Re: Beating the dead horse....

Postby daggaz » Mon Dec 08, 2008 11:04 am

As much as some people hate him, watch Michael Moore's documentary, "Sicko." Failing that, actually travel to ANY first world country in the world besides the USA. Please note they are not failing economies, tho everybody is feeling the heat from the US fiasco. While in said country, get hurt. See what happens.

That's about all I've got to say on this issue. Arguing with fellow Americans about healthcare is like trying to convince a brainwashed slave to escape; they just dont want to leave the farm, and will even violently defend their servitude. Amazing..
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Re: Beating the dead horse....

Postby kwirl » Mon Dec 08, 2008 3:38 pm

While I was in Canada the big thing in the news was that they were looking at legislation to 'Americanize' their health care system. I was like 'Are you people serious?'

And I've seen Michael Moore's documentary, Sicko - Are you saying that the solution is to adopt the health care system in place by France or England or Canada? Do you feel that it would work in our country?

How does their infrastructure compare to ours? I mean I think of America as a really big, confusing place - Would something that works so well in a smaller country work so well in a large, sprawling country of bureaucrats that we have?
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Re: Beating the dead horse....

Postby Corth » Mon Dec 08, 2008 5:24 pm

I recently saw some 60 minutes or comparable show which had a segment on the french healthcare system. It was a very favorable report. Among other things, the French doctors routinely make housecalls. They're total compensation is in the range of $60-100k per year.

I'm not sure how they make it work in France.. but given the other options in this country available to smart ambitious people, if Doctors were making $60-100k here, a lot of people, not all, but a lot, would simply stop becoming doctors. They have to go through like 5 years of school after college, and then a few years of residency on top of that. They usually graduate with enormous amounts of debt. Not many people would subject themselves to that when there are so many other options available to make more money with less time and tuition invested.

This really isn't my topic.. but it seems to me that there are probably a couple of other expenses, beside the compensation that doctors earn, that are making things horrendously expensive. First and foremore, malpractice insurance costs. On one hand, if you were the victim of negligence you would want to be compensated. However, its gotten to the point where malpractice insurance costs well over $100k per year for some specialties. Obviously that cost ultimately is paid by either the consumer of medical services, his/her employer, or the taxpayer. Second, it seems that there is a lot of beaurocracy involved with the health insurance companies that perhaps is unnecessary. We want doctors making medical decisions.. some beaurocrat in a cubicle should not tell doctors that such and such procedure is not warranted.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth

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Re: Beating the dead horse....

Postby kwirl » Mon Dec 08, 2008 6:09 pm

Agreed - I definitely think that simplification could eliminate a lot of extraneous costs, and our country seems to be a cesspool of litigation. People with financial problems go out of their way to look for ways to use a lawsuit to 'strike it rich' - something I think needs to be put in check.

Doctors are human, and last I checked none of us could be perfect. Our doctors should not be restrained by the fear of being sued out of business, using it as a justification to withhold treatment and care. From what I've heard medical insurance costs are outrageous, mostly due to fear of malpractice suits with punitive settlements.

Corth said it better than I, so I'm being repetitive. However, I think part of any new health care plan should definitely include a serious oversight of the existing claims process, as well as an evaluation of the necessity of forcing small doctors to budget a majority of their finances towards protecting themselves with overpriced and underserviced insurance policies.
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Re: Beating the dead horse....

Postby Kifle » Mon Dec 08, 2008 8:55 pm

Corth wrote:I'm not sure how they make it work in France.. but given the other options in this country available to smart ambitious people, if Doctors were making $60-100k here, a lot of people, not all, but a lot, would simply stop becoming doctors. They have to go through like 5 years of school after college, and then a few years of residency on top of that. They usually graduate with enormous amounts of debt. Not many people would subject themselves to that when there are so many other options available to make more money with less time and tuition invested.


If this were truly the case, we wouldn't have anyone teaching college except in your more prestigeous schools like Harvard, Princeton, Cornell, etc. To get a PhD in any arts program, you're usually looking at 2yrs for your MA and 2 more years of coursework towards a PhD; plus, it usually takes roughly 4-7yrs to write the dissertation for the majority of the candidates. Becoming a doctor is actually easier than becoming an Arts professor in most cases. And professors that aren't tenured make roughly 50-70k at most universities; the 70k is being very liberal in the estimate as well. Tenured professors at my school, those that have been there for 20+years, make around the 80-90k range.

To be completely honest, I think there is an undeserved stigma surrounding the MD field in relation to the work required to become one. I really wouldn't consider most doctors I've been to to be anything over "above-average" in intelligence either. The debt, on the other hand, is definately a drawback, but if the expected wages didn't compensate for the expected debt, you'd see the price of the MD falling just as quickly.
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Re: Beating the dead horse....

Postby kiryan » Tue Dec 09, 2008 12:17 am

I work in healthcare for a system that manages hospitals, clinics, runs a foundation (and free clinics) and sells insurance. I also have followed healthcare for about 7 years and targetted it for employment. Here are some lines of thought I have been exposed to.

I was talking to a CMIO (chief medical information officer) who speaks with people who testify before congress. There is a large discussion going on about how medicare/medicaid is responsible for a lot of our problems. The two big parts are that they drive down compensation for general practice physicians which results in fewer doctors and less preventive care if you can find one... and private insurers only have to insure you to age 65 so they focus on keeping you healthy just until age 65 even if its detrimental to you long term.

Insurance companies continuously work to push the costs for individual procedures down... like office visits, shots, meds, ect... This is lead by medicare/medicaid (the largest insurer) but also followed by private insurers. The result is that doctors try and see as many patients as possible... to increase their compensation. The average doctor has to see 4 patients an hour for 8 hours. We have some doctors that squeeze in 6 to increase their "efficiency" which translates into compensation. I've heard anecdotal stories about doctors seeing you only for what you came in for and requiring another appointment for anything outside of scope, even if its easy. revenue generation...

"lab tests" also generate revenue for the system... my opinion is that there is a push to order all covered tests. Whether its for profit or to protect you from mal practice lawsuits, there are a lot of tests ordered...

Doctors get compensated a lot better for acute conditions than for preventitive... why spend time talking to the patient about how to be healthier rather than just take care of their immediate need and moving on to the next patient? You've only got 15 minutes, I mean 10, with the patient anyhow...

Specialists get compensated a lot better than general practice. Specialists almost by definition handle more acute cases and are basically not involved in preventive healthcare.

Private insurers insure you up to age medicare/medicaid age... relatively speaking the healthy part of your life. Government picks up the tab for the most expensive part of your life.

---

now if you need further proof that government should not be in charge of healthcare. Here is a story from the medicare/medicaid audit of our insurance plan at my hospital at which I was there to answer database questions.

The question posed to me was what are you doing to make sure that people in the database don't have multiple records. My answer was we use the state provided medical ID number. They asked if we do anything else to deduplicate. I said no and added that we shouldn't have to because its the state's unique ID for each medicare/medicaid recipient and that deduplication is a bottomless hole of effort. I wrote programas to deduplicate "sales leads" databases for banks.

So I proceeded to get my ass lectured about how we should be doing more because the state makes a lot of mistakes and we need to engage with other parties to deduplicate the states database. The reason deduplication is important is not because of gaming the system, its because if you don't have the whole picture of a patient's past medical history, you are not providing the best possible care which is the state's mission.

I would say that fully 30% or more of our health plan FTE is focused around meeting state/federal medicare/medicaid requirements. You would not believe the amount of auditing and reporting that we are essentially required to do in order to collect reimbursements... and the requirements are CONSTANTLY changing. Working with healthplan is like constantly preparing to jump through the next medicare/medicaid hoop.
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Re: Beating the dead horse....

Postby kiryan » Tue Dec 09, 2008 12:35 am

Some philosophical comments on healthcare.

We need to change the notion that we are all entitled to affordable healthcare and the corollary that we are all entitled to the same non elective healthcare.

IMO if you are poor and need a new heart, you just die. If you get cancer and can't afford treatments, is real sad, but die. If the government is going to cover this kind of stuff, it should be based on an investment strategy. If your long term value as a tax paying citizen is good enough, then we save you. If you generate no income for the government, its a bad investment.

Licenses and Certification = artificially high wages due to supply and demand. We could bring down healthcare costs by making more doctors available... sure some of them wouldn't be as good as others, but this is where market forces step in. Better more highly qualified doctors would earn more money and lesser doctors can do lower end cheaper work.

Reducing licensing would also theoretically reduce the cost of becoming a doctor.

There are some programs gaining steam where instead of a doctor you have a super nurse (nurse practitioner). In the last couple years we have seen the first PhD in nursing programs, but folks are scratching their heads and saying why not just be a doctor (MD). Doctors are of course anti these programs because it undermines their compesnation.

Mal practice lawsuits need to be reworked. Doctors "practice" medicine and we hold them to too high of a standard. This is not math where you can make the right decision every time.

This is another area where the market could help. If you want a super perfect doctor, then pay for the doctors with the best records who take out supplemental insurance to cover their mistakes. If you can't afford it, then get your care off the Internet and/or from a less rigorously educated and experienced doctor
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Re: Beating the dead horse....

Postby Corth » Tue Dec 09, 2008 12:49 am

Wow.. and they call ME cold. :)

I'd like to see a situation where healthcare becomes affordable for most people. Real tort reform, imho, would go a long way towards that. At the same time I don't think we are a civilized country if we simply allow people to die because they cannot afford routine procedures that would save their life.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth



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Re: Beating the dead horse....

Postby kiryan » Tue Dec 09, 2008 1:03 am

its simple supply and demand isn't it?

How do you decrease demand when its free?

Government itself has restricted the supply through licensure, inhospitable business climate (malpractice) and increase the costs through regulation.
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Re: Beating the dead horse....

Postby Corth » Tue Dec 09, 2008 1:19 am

This is one of those things where I'd prefer to create incentives for increases in the supply of healthcare, rather than destruction of demand through premature death.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth



Goddamned slippery mage.
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Re: Beating the dead horse....

Postby oteb » Tue Dec 09, 2008 1:29 am

kwirl wrote: I mean I think of America as a really big, confusing place - Would something that works so well in a smaller country work so well in a large, sprawling country of bureaucrats that we have?


Seriously... If I don't think you know what bureaucracy is. Unless you have been to Europe.
Just a simple example. When I was in US I had to get a new driver's license (mine was not valid). All I had to do was show a proof that I am a citizen of Illinois. To prove it I had to show 2 letters addressed to me stamped by Illinois post. I sent two scarps of newspaper and got em back next day.
Same thing in Poland took me 2 weeks to gather all needed papers from various city offices.
For my friend in France it took even longer just to validate his Polish drivers license(back when we were outside EU)
Right now my company is in process of applying for 2 publicly founded contracts. The amount of papers we are obliged to gather is totally mindnumbing. It took me close to a week of work just to apply to all institutions for all certificates (that I am a regular tax payer with no debt, that I was never tried, that I am a member of architect union and 10 others like that) and another month to actually receive them.
Sorry for rant by recently its my personal pet peeve.

As for health care. It's a proven fact that Americans spend per capita more and health care than Europeans and on average get worse treatment. Last report I read put upper middle class-lower high class American treatment on same level as basic health care in Europe. I do believe in free market but just some thing work better when they are public. You could privatize all roads but having a toll booth at every corner wouldnt be a genius idea.
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Re: Beating the dead horse....

Postby Ambar » Tue Dec 09, 2008 2:07 pm

Corth wrote:Wow.. and they call ME cold. :)

I'd like to see a situation where healthcare becomes affordable for most people. Real tort reform, imho, would go a long way towards that. At the same time I don't think we are a civilized country if we simply allow people to die because they cannot afford routine procedures that would save their life.


Obviously Kiryan has seen no hardship in his life .. let one of the Brady Bunch get SERIOUSLY sick and see how his tune changes regarding health care.

Heh another story .. my dad's lady friend has cancer .. for a year and a half they treated her for one kind then said *oops* you havent died yet, its not that kind at all, let's try again .. the cost of one set of radiation then chemo round out of pocket was over 30k

I don't see Kiryan letting Peter Brady die because he has cancer

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Re: Beating the dead horse....

Postby avak » Tue Dec 09, 2008 3:12 pm

Yeah Ambar, but then he would say the same bs he said about schools...because the system exists he'll take advantage of it.

inhospitable business climate


Now that is ironic use of language given the subject.

Anyway, I'm almost convinced he's just tef-style trolling. I love the idea of children dying of asthma attacks at the steps of an emergency room because their parents didn't have health insurance. Or the 22 year old kid between undergrad and law school that gets in a car accident with a drunk driver, but 'just dies' because he doesn't have health insurance to cover the treatment. Or the 63 year old grandmother that, eight months after her husband, and sole bread winner, dies with a sudden and major hospital bill and while trying to get money together her own health care, has a stroke and goes into a coma.

We all pay for it anyway. So unless our country decides to be as selfish and myopic as Kiryan, we should look at a better strategy.

For example, Denver Health, a public hospital system, had a 19 percent increase in emergency visits by uninsured patients in November — to 3,325, up from 2,792 a year earlier.

Denver Health expects the amount of care it delivers for which it will never be paid to grow to more than $300 million this year, compared with $276 million in 2007.
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Re: Beating the dead horse....

Postby kwirl » Tue Dec 09, 2008 5:20 pm

I can see Kiryan's point, and to some degree it makes sense. However, isn't the more expensive part of serious illness in the later stages? Wouldn't it be cheaper to spend a small(er) amount on detection and prevention? I don't know for sure, but I assume that the 'poor' people often reach extreme conditions because they either do not or can not spend the money for early detection when the options would be less overwhelming.
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Re: Beating the dead horse....

Postby daggaz » Tue Dec 09, 2008 7:19 pm

France aside (especially their universities), European beaurocracy is not much different or worse than the states. Denmark is one of the more socialist countries, and you would think therefor, one of the more beaurocratic, but it doesnt really take too much time to get things done. It took me about fifteen minutes to get my drivers license changed over. It might take a while in the emergency waiting room if you arent hurt worse than others, but the actual paperwork is absolutely minimal in comarison to American insurance forms.

One thing people need to stop saying is "but USA is physically different." Its not, really. You have countries that are smaller and far more densely populated, like Germany, where socialized health care works great. Think the northeastern seaboard. You have places like Norway where it works great. Think the Pacific Northwest. You have places like Spain where it works just fine and dandy. Think California and the SouthWest. Really, there is no demographic, economic, or social reason that this system which works around the world, would not work in the USA.

The only reason you dont have it, is because there has been a concerted effort to block it ever since federal power in the states really began consolidating. Nixon was instrumental. As were big pharma, insuracorps, and other private capitalist entities who were/are more interested in big profits than in fulfilling a basic human need as it is done in most of the rest of the civilized world.

PS: Oregon, my home state, has socialized health care, if you are poor enough. It worked great, tho not nearly as well as it does over here. Hawaii has this too.
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Re: Beating the dead horse....

Postby Corth » Tue Dec 09, 2008 9:51 pm

Again, not my issue. How would you respond to the critics of univeral healthcare who point out long waiting lists for procedures and appointments in countries like Canada and Britain? Is that overblown?
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth



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Re: Beating the dead horse....

Postby daggaz » Tue Dec 09, 2008 11:49 pm

absolutely a valid point.

I broke a tendon in my thumb, and lost use of the digit. In the states, with proper insurance, I would have had surgery within a few hours most likely. In denmark, I did have to wait almost a month for the procedure (please also keep in mind that Denmark is a tiny country, smaller than most American counties) which sucked, and resulted in a slightly more complicated surgery. But, I got the surgery for free, and it was a complete success. I am typing with my thumb right now (well, the space bar, heh).. I also got "sick pay" for the entire duration, both waiting and recovery, as I couldnt work without my hand.

In the states, at least any state but Oregon and Hawaii, where they do have socialized health care for poor people, I would never have gotten the surgery at all and would be crippled until I could afford it. Or maybe I would have had some crappy HMO who decided to dick me out of the coverage so they could save a buck, and I would have been crippled by hospital bills.

So really its a question of longer lines for everybody, or really short lines for some people and no help, or devastating bills, for the rest. How many millions of americans do not have health coverage? How many of those are children? How many people who file for bankruptcy do so because of medical bills?

I will go with the longer lines, myself. Its a decision I am glad to make. For myself, and for my fellow human beings. And if you are seriously ill, or have a major accident, you are rushed to the hospital in a helicopter if need be, and treated immediately. For free. Obviously they prioritize their resources and fast track those most in need. But you aren't going to die waiting in line. You certainly aren't going to die on the steps of the hospital because you were refused access, in violation of the hypocratic oath.
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Re: Beating the dead horse....

Postby kiryan » Wed Dec 10, 2008 12:13 am

I would not change my tune if one of my kids got sick.

If it cost me 100k to save one of my kids, I'd probably spend it as long as I had it or as long as others would provide credit... I would sacrifice my future for theirs while hoping one of them will take care of me when I get old. I would take personal responsibility and make personal sacrifice if I was in this situation.

What do you want me to do, be angry at the government for not providing free care? Be angry at my employer for not paying me enough to provide unconditional medical coverage for any ailment? Should I get uber depressed and give up on life and whine and bitch and not work because I'm so f*d up? Life goes on and regardless of how you feel you do what you need to do.

We take all the tough choices out of our society all the responsibility. We expect the government to protect us from bad decisions and bail us out of any supposedly unforseeable circumstance. It is the nanny state, where government has to make sure "predatory" lenders don't take advantage of poor stupid blacks and hispanics. You don't have to actually think or plan, just keep going to work and paying taxes and the government will take care of all needs.

simply stupid.
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Re: Beating the dead horse....

Postby Kifle » Wed Dec 10, 2008 12:43 am

kiryan wrote:I would not change my tune if one of my kids got sick.

If it cost me 100k to save one of my kids, I'd probably spend it as long as I had it or as long as others would provide credit... I would sacrifice my future for theirs while hoping one of them will take care of me when I get old. I would take personal responsibility and make personal sacrifice if I was in this situation.

What do you want me to do, be angry at the government for not providing free care? Be angry at my employer for not paying me enough to provide unconditional medical coverage for any ailment? Should I get uber depressed and give up on life and whine and bitch and not work because I'm so f*d up? Life goes on and regardless of how you feel you do what you need to do.

We take all the tough choices out of our society all the responsibility. We expect the government to protect us from bad decisions and bail us out of any supposedly unforseeable circumstance. It is the nanny state, where government has to make sure "predatory" lenders don't take advantage of poor stupid blacks and hispanics. You don't have to actually think or plan, just keep going to work and paying taxes and the government will take care of all needs.

simply stupid.


Getting sick isn't a bad decision and has, usually, absolutely no baring on individual responsibility. If anyone can be blamed for people getting sick, it's God. So fuck him, right? It wasn't my responsibility that led to the economy going to complete shit, but I still have to survive in it while there are, realistically, no jobs that I can get which will pay me enough to afford excellent health coverage even half-way comperable to Daggaz's coverage. And I'm college educated. It's not like I haven't worked hard, through shit a lot of people would have thrown in the towel on. So, where have I refused to own up to my responsibility in this society that offers coverage to people who've made good decisions? Face it, your ideal system is predetory, inhuman, and predicated on complete shit. And I'm being nice when I say complete shit as that is quite the understatement in relation to your overall worldview.
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Re: Beating the dead horse....

Postby kiryan » Wed Dec 10, 2008 12:56 am

Another piece to the whole medical costs pie is regulations requiring hospitals to provide care to basically anyone who walks into a hospital emergency room. I believe they get reimbursed a small amount through most states/medicare/medicaid for uninsured, underinsured, and straight out illegal immigrants, but its not nearly enough to cover the "costs" (which are high for a variety of reasons). Being forced by the government into this high cost low or negative business makes these companies reliant on the government for basic solvency.

Beyond the pressures of having to provide free care, you have competition from private clinics with urgent care departments. They don't have "emergency departments" so they can turn away severe trauma patients (expensive) and under/uninsured patients. Its basically cherry picking the highest margin cases... very profitable.

Hospitals are at a clear competitive disadvantage in todays market place because of government interference. BTW expect a healthcare bailout and massive hospital failures next year. Healthcare and hospitals tend to follow about 6 mos to 1 year behind the general economy. Some directors I was talking too commented that at a pretty grim picture was painted at a conference they went to in September or October... the recession is about to hit hospitals and given the unemployment #s its going to be very bad.
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Re: Beating the dead horse....

Postby shalath » Wed Dec 10, 2008 9:29 am

Corth wrote:Again, not my issue. How would you respond to the critics of univeral healthcare who point out long waiting lists for procedures and appointments in countries like Canada and Britain? Is that overblown?


Yes, in the United Kingdom, there are waiting lists for the National Health Service (NHS). They are not hugely long waiting lists, and they depend on the specific situation, but they do exist. We make a distinction between emergency care, primary care and secondary care, which I will explain below.

Emergency care is open to everybody. Irrespective of whether you are a citizen, a resident, a visitor or an illegal immigrant. Indeed hospitals will not work with the immigration authorities, because to do so would discourage illegal immigrants from visiting them. The job of an A&E unit (Accident and Emergency) is to save lives. They're where you go if you were in a car accident, or if you think your child has meningitis, or if you show any kind of acute symptoms which you think are dangerous. This care is free, and you are seen immediately. Well, triage is performed immediately by an experienced nurse who is trained to spot urgent cases, and if it's something that cannot wait (say you're bleeding all over her registration paperwork, or have symptoms of a dangerous illness), then you will be seen immediately. Otherwise it may take a while - say on a Friday night when people have been drinking and A&E is crowded you might have to wait a few hours. But you will be seen and treated by a full team of nurses, doctors and a consultant. This care is free, and applies to all human beings equally, as it absolutely must.

Primary care is mainly in the hands of your GP (General Practitioner). Every British resident (anyone with a legal right to live and work in the UK, automatically including all EU citizens) has a right to free primary care. They must register with a GP, and then can make an appointment to visit them at any time. This is the main point of contact for NHS patients. An appointment is usually available the same day if you call in the morning, and most GPs provide at least two or three evening surgeries for people who need to see a doctor but cannot make it during the day. GPs also provide "out of hours" appointments, where you want to see a doctor urgently but things are not life threatening. If there is a reason that you cannot make it into an out of hours appointment, they will usually be able to organise a house call. The GP is responsible for initial diagnosis of symptoms, and when needed can refer patients for tests, or to a secondary care unit such as a hospital under the care of a specialist consultant. Registering with a GP and using their services is free for residents. People from other countries can use GP services but may have to pay. The charges are not extortionate, and certain conditions are always free to everyone (for instance pregnant women will always be registered and treated for free unless it is determined that they have come to the UK explicitly to abuse this facility - this is one of the rare situations where healthcare providers work with immigration to make sure that this does not happen). Children are always treated for free no matter where they are from.

Secondary care is where the specialists work. These are mainly hospital wards where you go for diagnosis of specific symptoms that your GP cannot help with, or treatment for specific illness that your GP cannot treat, or tests such as MRI scans. Access to these is by referral from a GP (or sometimes from an A&E doctor if appropriate), and there is usually a waiting list. This is where you hear of people sometimes having to wait for a number of months before a specialist can see them. It is an unfortunate fact of life that resources are limited - only so many people can be scanned per day because there is only X number of MRI machines, only so many people be seen by the consultants per day because there is only a limited number of consultants. However, this care is free, and this is not treatment for life-threatening illnesses (in most cases).

But I have private medical insurance. What?! You say? If your system is so great, why do you need private medical insurance? Well, I don't *need* it. The reason to have private medical insurance in the UK is to gain faster access to secondary care. Indeed I am due to go under general anaesthetic next Monday. This would have taken about three months on the National Health Service, but instead I called my private medical insurance and they arranged for it to happen within about two weeks (there was a next day appointment available if I wanted it, but those who know me know that I travel a lot and so I had to schedule something like this in). My company pays for my private insurance, for me and my whole family, because they believe that it is in their interests to look after me and get me back to good health as quickly as possible if I become ill. It's still well worth having for faster access to secondary care. However it does not influence my use of emergency or primary care at all. My first port of call in an emergency is still A&E, and my first contact for anything else is still my GP - it's just that when my GP refers me for tests or to a specialist, the private appointments are available immediately rather than waiting.

The free health care system works. It has flaws of course; people fall through the cracks, and you do hear horror stories of people waiting for half a year before being told by the specialist that it's now too late to do anything. Yes, bad things happen. But not for lack of trying. On the whole the system is designed to be humane and to treat everybody equally, such that no-one should suffer because they cannot afford to see a doctor. I think the NHS, even with all its flaws, is significantly better than the "system" in the US, and I do not begrudge a penny of the money that I pay in taxes each month to keep it going.

-simon
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shalath
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Re: Beating the dead horse....

Postby shalath » Wed Dec 10, 2008 9:40 am

Corth wrote:given the other options in this country available to smart ambitious people, if Doctors were making $60-100k here, a lot of people, not all, but a lot, would simply stop becoming doctors. They have to go through like 5 years of school after college, and then a few years of residency on top of that. They usually graduate with enormous amounts of debt. Not many people would subject themselves to that when there are so many other options available to make more money with less time and tuition invested.


In the UK, it doesn't cost anything to become a doctor. Tuition is free, as long as you get into medical school (you need to pass exams and demonstrate you are good enough to train). Of course you need to pay for your own living expenses, but if you can't afford those there are means-tested grants and cheap student-loans (which you don't start to pay until you start earning a reasonable amount) to help with living expenses. I guess our solution is that if the country needs doctors, we take smart people and train them to be doctors.
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kwirl
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Re: Beating the dead horse....

Postby kwirl » Wed Dec 10, 2008 5:08 pm

Thanks, Shalath for the very informative and educational reply. I have to admit, it sounds like the way to go. The question then becomes, however, How do we migrate our existing system into one that works like that without enormous loss. My pastor made a point about change that seems relevant.

He was repairing a house that was built in the late 1800's, and in the course of the 100+ years that the home was maintained, it had used all manner of internal wiring for getting power. Every time that there was a 'change' in how wiring was done, they simply patched up or worked around the existing wiring. After a hundred years, you are talking about a veritable mess of wiring. The cheap solution is to just work around what is already there again. The GOOD solution, however, is to remove all of the old useless clutter that just gets in the way and complicates things and put a new schematic into play.

One of the details of our country that feels flawed to me is how bureaucracy works on momentum. Even the IRC (tax code) has never been fundamentally re-written, we just use annual work arounds for the sake of simplicity, which makes managing taxes increasingly complex and as a result, increasingly exploitable by those with the resources to manipulate their finances to accommodate the resulting loopholes. It applies to most levels of involvement with our major problems. What is wrong with our tax code? Complexity and an un-willingness to support expensive legislation to change. What is wrong with our health care? Complexity and an un-willingness to support expensive legislation to change. I'm sure without much effort we could probably lay down a dozen or so 'broken' systems in America that have the same problem.

'Fixing' our health care system is something that seems unlikely simply because our political system is based on a popularity contest, and sometimes, doing the right thing just will never become popular, so it will take a tremendous outpouring of public support to make it actually happen.

Sadly, public support is often financial to a politician, and to the people that have the money to 'support' - the things that are a problem just won't get changed.

15 billion dollars to bail out our automotive industry (which is itself, a bloated beast) yes, please. There are shareholders and executives and many other people with a lot of money that need this industry to survive.

The people who need health care to survive are the people who don't always have the kind of money needed to make their voice heard.
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Re: Beating the dead horse....

Postby Corth » Wed Dec 10, 2008 5:25 pm

Are there any countries where there has been a socialized health care system in place for a long period of time? I would be interested to see how it works over time. One of the concerns is that less people become doctors under such a system. I would be interested to see if the waiting list gets worse over time.
Having said all that, the situation has been handled, so this thread is pretty much at an end. -Kossuth



Goddamned slippery mage.
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Re: Beating the dead horse....

Postby Botef » Wed Dec 10, 2008 5:27 pm

kiryan wrote:Another piece to the whole medical costs pie is regulations requiring hospitals to provide care to basically anyone who walks into a hospital emergency room. I believe they get reimbursed a small amount through most states/medicare/medicaid for uninsured, underinsured, and straight out illegal immigrants, but its not nearly enough to cover the "costs" (which are high for a variety of reasons). Being forced by the government into this high cost low or negative business makes these companies reliant on the government for basic solvency.

Beyond the pressures of having to provide free care, you have competition from private clinics with urgent care departments. They don't have "emergency departments" so they can turn away severe trauma patients (expensive) and under/uninsured patients. Its basically cherry picking the highest margin cases... very profitable.

Hospitals are at a clear competitive disadvantage in todays market place because of government interference. BTW expect a healthcare bailout and massive hospital failures next year. Healthcare and hospitals tend to follow about 6 mos to 1 year behind the general economy. Some directors I was talking too commented that at a pretty grim picture was painted at a conference they went to in September or October... the recession is about to hit hospitals and given the unemployment #s its going to be very bad.


What exactly are you suggesting as the alternative here, that we give hospitals the authority to turn away people who put them at a competitive disadvantage? I agree that emergency rooms are grossly overworked by cases that are definitely not an 'emergency' in the true sense of the word, but it is in most situations the only alternative for people who do not have insurance and cannot pay for their care out of pocket on the spot. Taking away one of the only alternatives for uninsured health care could be detrimental not just to uninsured people's health, but everyone else as well.
Sunamit group-says 'imrex west, tibek backstab touk i think his name is on entry'
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shalath
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Re: Beating the dead horse....

Postby shalath » Wed Dec 10, 2008 6:40 pm

Corth wrote:Are there any countries where there has been a socialized health care system in place for a long period of time? I would be interested to see how it works over time. One of the concerns is that less people become doctors under such a system. I would be interested to see if the waiting list gets worse over time.

How long do you consider to be a long period of time? Our National Health Service has been in place for 60 years, since the second world war. During that time we have had ups and downs but generally people try to do the right things, and fix the problems as they arise.

The problems you're describing (less people becoming doctors, waiting lists getting longer) are transient. Sometimes they're worse, sometimes they're better, but they have no bearing on the long term effectiveness of the system.
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kiryan
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Re: Beating the dead horse....

Postby kiryan » Wed Dec 10, 2008 9:38 pm

I'm not suggesting anything, I'm sharing what I know and understand about the healthcare industry. There is a big problem in the marketplace. Hospitals specifically are under a tremendous financial strain due to the requirement to provide free care.

You've seen the national report card on emergency care? We as a nation basically got low marks. The 5th best state got a C+. Let me tell you how that happens. First its the measures they use and their standards ect... but putting that aside, its because hospitals are under financial pressure directly because of their emergency rooms. So they lower the staffing in their emergency rooms to lower their exposure to uninsured cases... it literally costs them money. Secondly, by lowering their emergency staff and increasing wait times, you can get higher occupancy in your inpatient beds (upstairs). So you have fewer nurses standing around upstairs waiting for patients. You also might get a government grant/bailout to help you provide more emergency care (their are lots of these grants, especially for rural areas).

Sure there are tons of other factors, but there is very little private financial incentive to run an emergency room. Regulations bascially result in no private investment in emergency care and reduced services. Imagine if government ordered McDonalds and Burger King to serve a plain hamburger to anyone who didn't have money. Would you invest in McDonalds? and its gonna get worse. hospital bankruptices by the dozens if people en masse remain uninsured (through job loss) for more than 6 months, if we have these kind of job losses for 1 year, we will need to talk about a healthcare bailout.

--

The problem with not cutting uninsured off... besides the financial strain on private businesses is the lack of personal responsibility. If you didn't have a safety net, more people would take personal responsibility to provide their own coverage.

I didn't buy insurance coverage until I bought a house 11 years ago and... it appreciated 100k for me. Now I have to maintain it because I'm responsible for a family, but 8 years ago I didn't have to. Reason being is I could get free healthcare at a hospital if I need it and just declare bankruptcy on the bills and still keep 40-80k of equity in my house. Every person I know without health insurance owns at least 1 car newer than mine, a game system and a 40" TV. They eat out frequently and save nothing. The only way they will pay for healthcare coverage is if its reasonably priced through work. People need to take personal responsibility, not rely on the government to take care of them.

If I was poor and sick in Mexico you bet your ass I would come to America if not just for free healthcare and education for my children.
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Re: Beating the dead horse....

Postby daggaz » Fri Dec 12, 2008 7:53 pm

Corth wrote:Are there any countries where there has been a socialized health care system in place for a long period of time? I would be interested to see how it works over time. One of the concerns is that less people become doctors under such a system. I would be interested to see if the waiting list gets worse over time.



Most of the worlds countries which have universal health care, have had these systems in place since WW2. I have a feeling that France has had theres in place for far longer, tho dont quote me on that.

60 years is a long time, especially if you look at the last 60 years and all the changes we have seen in population growth, technology, etc, etc.. All of these countries have encountered problems, none of them are utopias, but all of them have surviving and well working health care systems.

I think that speaks for itself.

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